Background: Umbilical pilonidal sinus (UPS) is a rare condition characterized by the formation of a sinus tract in the umbilical region, often associated with chronic inflammation and hair accumulation. Accordingly, due to its rarity and nonspecific presentation, UPS is frequently underdiagnosed, leading to delays in appropriate management. Objective: In this article we systematically reviewed all the literature on UPS in Saudi Arabia and worldwide to formulate a clinical picture, a possible management algorithm and report noted outcomes. Case presentation: This is a 19 years old, male patient, known to have autism spectrum disorder with a prior umbilical hernia repair (when the patient was 6 years old). The patient presented to the out-patient clinic when he was 17 years of age with his parents, complaining of minimal umbilical serous discharges. Upon examination, the area had poor hygiene and villous hair all around the umbilicus. The patient was followed every 3 months with no noted changes, yet after 1 year of follow up, a small umbilical swelling 1x2 cm was noted with 2 pits and hemo-serous discharges with surrounding hair tufts, no hernial recurrence noted. The family was counselled on risks and benefits of conservative versus surgical excision, and they opted for surgical excision. The patient’s pre-operative laboratory workup was normal. Post-operatively, the patient was doing well with no complaints (e.g., pain or discharges), however after 2 weeks the patient developed a small hematoma that was aspirated, other than that the follows ups were unremarkable. Discussion: Clinically, UPS is more common in males with several correlated risk factors (e.g., hirsutism, deep navels, BMI >25 kg/m2, positive family history of pilonidal sinuses) that were derived from the analysis, in which a diagnostic criterion is proposed and a “Step-up” management approach. Conclusion: The current case report and systematic review highlight the diagnostic challenges of UPS and reviews the spectrum of management options (i.e., conservative vs surgical techniques). As there is a noted international scarcity in UPS-related data, to provide patient-centred and evidence-based care.

Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a type of invasive fungal rhinosinusitis that is characterized by the presence of pathologic findings of non-caseating granulomas in the paranasal sinuses. This article describes two cases of CGIFRS with fatal outcomes. The first case was for a 36-year-old man who presented with headache, dizziness, and vomiting for 1 month. This patient had received the traditional treatment, although the patient’s condition suddenly deteriorated after 1 week of surgery and died due to the disease’s complications. Similarly, the second case was for a 31-year-old man who presented with bilateral nasal obstruction and left eye proptosis for 1 year. This patient had a recurrence of CGIFRS after the first presentation, which was complicated by a cerebral abscess after 2 months of surgery. This study, therefore, underscores the severity of CGIFRS as a potentially fatal disease.

A small bowel perforation caused by ingestion of plant stems or herbal twigs is rare, with inherent diagnostic challenges (i.e. secondary to radiological translucency and nonspecific manifestations). This is a 50 years-old male, who is edentulous and habitually drinks tea using Ocimum every evening, presented to the emergency department with lower-quadrants abdominal pain for 1 day with no prior history of an animal meat-based meal (e.g. fish, chicken). The labs revealed minimal leucocytosis, and the abdominal computed tomography showed a hyperdense linear foreign body penetrating through the terminal ileum. The patient was stable and underwent bowel resection and anastomosis with an uneventful post-operative course. Therefore, even in edentulous patients with no foreign bodies (e.g. bones, toothpicks) possibly ingested, herbs might be a rare cause worthy of investigation.

Background: Traumatic injuries contribute to over 5 million fatalities each year and cause a significant burden on healthcare systems' resources and availability. Traumatic injury patterns and a healthcare system’s efficiency are critical to predicting patients’ outcomes and should be regularly evaluated to deliver optimum care. Objective: The study will present and discuss trauma qualty indicators (TQI's) to display the local practices' opportunities for improvement and analyze patterns of traumatic injuries and outcomes. Methods: The study retrospectively analyzed trauma cases from January 2016 to December 2020, in which patients hospitalized and treated under the trauma unit were included. The collected data included several variables (e.g., demographics, mechanism of injury), and the patients were divided into early/late phase and severe/non-severe cases. Results: In total, there were 2024 cases, 70% were polytraumas with a mean age of 29 years and a male-to-female ratio of 3.8:1. The most common mechanism of injury was motor vehicle collision (55%) while the most common injuries were pneumothorax (18%) and lung contusions (17%). Notably, there was a 3.5-hour reduction in both the time to the operating room and the time to normotension when comparing the early to late phase. The 30-day outcomes for the patients were 90.5% recovery, 2.2% disability, 2.2% transfer, and 5.1% mortality rates. Conclusion: This study emphasizes how crucial trauma quality indicators are to achieve the best outcomes for patients. The results point to improvements in terms of trauma quality indicators and offer insightful information on patterns of traumatic injuries, aiding in the enhancement of trauma care. Thus, the continuous assessment of trauma quality indicators and the implementation of preventive measures are mandatory for the future advancement of trauma care.

Despite tremendous medical advancements in limb preservation, limb amputations are still considered a common procedure performed worldwide. This procedure can present distinct challenges, impacting patients’ quality of life both mentally and physically. The aim of our study was to analyze clinical characteristics of amputations and assess the quality of life in these patients. This was a retrospective single center study of patients requiring limb amputations was performed. Patient demographics, clinical data (including underlying diagnosis, level of amputation and type of surgical procedure) and outcomes (including complication and revision rates) were collected. Patient reported outcomes utilizing short form-36 (SF-36) were also documented. Descriptive statistics were analyzed and p < 0 .05 was considered statistically significant. A total number of 268 patients were included in the study with a mean age of 30± 24.7 years. Lower extremity amputations were the most commonly performed, and peripheral vascular disease and diabetes mellitus were the most common underlying cause for amputation. Complications were encountered in 16.8% and 12.3% of patients required a revision. We found a significant association of complication and revision rates with lower extremity amputations and peripheral amputations (phalanx and metacarpal/tarsal amputations). In addition, patients with a complication or revision were found to be significantly older. Type of surgery, level of amputation and gender had no association with complication or revision rates. Concerning SF-36 scores, we found patients scored higher on health change (73±29.7) and lowest in role limitation due to personal or emotional problems (39.6±47). A relatively high rate of complications and revisions was found in patients requiring amputations. This highlights the need for both close post-operative assessment for these patients and a multi-modal approach to amputation care, addressing not only the surgical aspects but also the post-operative rehabilitation and emotional well-being of patients.